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Ankylosing Spondylitis

Article
Bone, Muscle, & Joint
Diseases & Conditions
+1
Contributed byKrish Tangella MD, MBAJun 24, 2021

What are the other Names for this Condition? (Also known as/Synonyms)

  • Rheumatoid Spondylitis
  • Spondylitis
  • Spondyloarthropathy

What is Ankylosing Spondylitis? (Definition/Background Information)

  • Ankylosing is a term that means stiff or rigid; Spondylitis refers to an inflammation of the spine
  • Ankylosing Spondylitis (AS) is a congenital inflammatory disorder that causes chronic inflammation of the spine and sacroiliac joint (a pelvic joint). Over time, the affected joints of the vertebrae within the spine fuse together. The disorder lasts an entire lifetime and predominantly develops in men
  • Pain and stiffness associated with a majority of this inflammatory disorder cases, is caused by enthesitis (inflammation of the area where ligaments and muscles connect to bones)
  • Ankylosing Spondylitis is one of a collection of arthritis-related conditions called seronegative spondyloarthropathy (joint disease of the spine). The term seronegative indicates that individuals with the condition, test negatively for the antibody rheumatoid factor

Who gets Ankylosing Spondylitis? (Age and Sex Distribution)

  • Individuals of all ages, race, ethnic groups, and gender, may develop Ankylosing Spondylitis
  • However, the condition predominantly develops in young men between 16-35 years old. It is less prevalent in women, in whom typically the signs and symptoms are milder and harder to identify
  • A small percentage of AS cases (approximately 5%) begin during childhood. When children develop this condition, mostly it starts with the hips, knees, bottom of the heels, or big toes,which later progresses to the spine
  • The Ankylosing Spondylitis gene is present in 8% of healthy Caucasians and in approximately 2-3% of the African-American population. Hence, it is 3 times more likely to develop in Caucasians, than African-Americans

What are the Risk Factors for Ankylosing Spondylitis? (Predisposing Factors)

Risk factors associated with Ankylosing Spondylitis include:

  • The disorder typically develops in teenagers, or individuals into their early adulthood
  • Men are more likely to develop AS than women
  • Studies have indicated that the disorder has a genetic prevalence. A genetic marker, known as HLA-B27, is present in a majority of the individuals who have Ankylosing Spondylitis. However, a high percentage of individuals (approximately 80%), who test positive for HLA-B27, never develop the disorder

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Ankylosing Spondylitis? (Etiology)

  • The underlying cause associated with Ankylosing Spondylitis, is currently unknown
  • Certain studies have indicated that the genetic marker HLA-B27 is present in a higher percentage of individuals, who have this disorder. However, the underlying causes associated with individuals who test positive for the genetic marker (HLA-B27), is presently not understood

What are the Signs and Symptoms of Ankylosing Spondylitis?

The signs and symptoms that are manifested, depend on the body region or location that is affected. Common signs and symptoms associated with Ankylosing Spondylitis include:

  • Excessive pain and stiffness in the hip
  • Pain within the heel
  • Abnormal pain and swelling in the shoulder, knees, and ankle
  • Enthesitis (painful inflammation at the site, where the ligaments and muscles connect to bones)
  • Feeling of tiredness
  • Pain in the buttocks
  • Loss of appetite
  • Excessive weight loss

How is Ankylosing Spondylitis Diagnosed?

Diagnostic methods that a physician may use to help diagnose Ankylosing Spondylitis include:

  • X-ray of the spine and pelvis: An x-ray is a diagnostic imaging test that may show if any abnormalities are present, within the joints and bones. However, certain characteristic features of AS, may make for difficult identification, during its early stages
  • Magnetic resonance imaging (MRI): An MRI is a more detailed scan that uses radio waves and a magnetic field to generate thorough images of the interior bones and soft tissues. An MRI scan may provide a clearer image of the surrounding tissues, such as a cartilage
  • Computerized tomography (CT): A CT scan takes a series of x-ray images from several different angles. These images are then merged to create cross-sectional images of bones and soft tissues of the body. This allows a physician to examine the spinal column and surrounding structures, in greater detail
  • Complete blood count (CBC): It is a blood test that also helps the healthcare provider in arriving at Ankylosing Spondylitis diagnosis. During this test, a blood sample is drawn from an artery or vein using a needle, and taken to a laboratory for analysis.
  • Erythrocyte sedimentation rate (ESR): ESR is a blood test (blood sample drawn from an artery or vein) that can help the healthcare provider identify any inflammatory activity within the body and determine the disease activity for AS

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Ankylosing Spondylitis?

Complications associated with Ankylosing Spondylitis include:

  • Inflammation of the eye (termed uveitis), which is one of the most noteworthy complications
  • Weakening of the vertebrae, resulting in a compression fracture
  • Breathing difficulties
  • Heart problems due to inflamed aorta and abnormally-shaped aortic valve within the heart. This may cause an aortic valve regurgitation

How is Ankylosing Spondylitis Treated?

The primary focus of Ankylosing Spondylitis treatment is to relieve pain and stiffness, and prevent or slow progression of the spinal deformity. The treatment measures include:

  • Non-steroidal anti-inflammatory oral medications, such as indomethacin and naproxen, are commonly used to treat Ankylosing Spondylitis. These medications help decrease the pain, swelling, and inflammation
  • It is important to begin some light motion exercises after the signs and symptoms have decreased. Physical therapy may help restore strength, as well as flexibility, in the muscles
  • Tumor necrosis factor (TNF) blockers may be prescribed, if non-steroidal anti-inflammatory oral medications prove to be ineffective
  • Surgical treatment is rarely required in individuals with AS. However, surgical interventions may be recommended, if excessive pain and joint damage is present

How can Ankylosing Spondylitis be Prevented?

  • Currently, there are no known preventative measures for Ankylosing Spondylitis. This is more so, because genetic factors appear to be a potential cause
  • Individuals, who are aware of the condition and the risk factors associated with AS, may help with early detection and treatment
  • Early and appropriate treatment can alleviate excess joint pain and prevent or slow the development of spinal abnormalities

What is the Prognosis of Ankylosing Spondylitis? (Outcomes/Resolutions)

  • Ankylosing Spondylitis is such a condition, with which it is very difficult to forecast the future progression
  • Some individuals may experience periods of increased disease activity, followed by a period of decreased activity. In such individuals, the acute inflammation is followed by a symptom-free remission period. After a certain duration of time, this remission period is followed by active inflammation and excessive pain
  • With treatment, the symptoms associated with AS can usually be relieved and controlled, so that the individual may have a productive life
  • Individuals who are not treated may develop osteoporosis, which may eventually result in a compression fracture

Additional and Relevant Useful Information for Ankylosing Spondylitis:

Only around 300,000 Americans, or less than 1% of the adult population, develop Ankylosing Spondylitis.

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